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KC, KH, DG, SL and JT declare that they are involved as investigators in a new trial of primary HPV screening in Australia, which will involve support from the manufacturers of new test technologies. Other authors declared no conflict of interest. This study was funded by the National Health and Medical Research Council Australia (NHMRC Project Grant #1007518) and by Cancer Council NSW.
JBL led the development of the Australian screening model, performed the modelling analysis for this evaluation, participated in the analysis of model outcomes, prepared the tables and figures and participated in drafting the manuscript. KH prepared cost information for the model and guided the interpretation of cost outcomes. DG provided screening registry data and guided interpretation of these data. MS participated in model development, data analysis, manuscript drafting and was responsible for the collation and integration of epidemiological data into the model. MC led the analysis of screening registry data and conceived the basic design of the screening model. CN participated in model development. JF participated in manuscript drafting. SD and SL performed systematic review of cytology accuracy for the model and assisted in the specification of model screening and management pathways. PC participated in the model development for and the analysis of screening registry data and test probabilities matrix to inform cytology accuracy. YJK performed review of precancerous lesion treatment success rates and post-treatment recurrence rates. JT provided colposcopy data from a large database collected at Royal Women’s Hospital, Melbourne, and guided interpretation of these data. KC conceived and led the project, participated in all aspects of the analysis, and drafted the manuscript. All authors read and approved the final manuscript.
The National Cervical Screening Program in Australia currently recommends that women aged 18–69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010.
A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination.
The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing $96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing $21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that $20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities.
Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the introduction of HPV vaccination, new technologies, increasing the interval and changing the age range of screening is expected to have a substantial impact on this expenditure, as well as having some impact on follow-up and management costs. These estimates provide a benchmark for future assessment of the impact of changes to screening program recommendations to the costs of cervical screening in Australia.